HWN Suggests

Tension pneumothorax – time to change the old mantra?

.. In treating a tension pneumothorax, we have traditionally been taught to place a large bore catheter in the second intercostal place (2nd ICS) mid-clavicular line, and this method is still advocated in ATLS guidelines. It is the obvious choice in terms of ease of anatomical location where speed is of the essence with a time-critical injury.

However, this approach may not be the most effective position to provide live-saving decompression and there is conflicting, and a lack of quality, evidence to support the 2nd ICS approach.

Assuming that your diagnosis is correct and accepting that each case should be taken on its own merits, we would suggest trying the 5th ICS MAL…

read full article

Featured

  Tension Pneumothorax – ED Management

Traditionally you enter the 5th ICS, midclavicular line, which is the nipple line in men, and at the level of the inframammary crease in women.

Articles of Interest

Changing Trends in the Decompression of Tension Pneumothorax

In 2018 the Advanced Trauma life support (ATLS) guidelines has changed and the ideal place for tension pneumothorax decompression is at the 5th intercostal space anterior to the MAL.

EM@3AM: Pneumothorax

Placement at the 4th/5th intercostal space in the anterior axillary line has lower failure rates compared to the traditional 2nd intercostal space in the mid-clavicular line.9

Sticking the knife in: Time to review management of tension pneumothorax

There is currently much doubt surrounding the effectiveness of needle decompression for tension pneumothoraces, and needle decompression without release of air certainly does not rule out this important reversible cause of cardiac arres

Tension Pneumothorax- Needle Decompression

Here’s a quick, 3 ½ minute video for physicians and paramedics on how to decompress the chest when you suspect a tension pneumothorax. The ATLS course now adds a consideration to use an alternative site. That location is the 5th intercostal space around the mid-axillary line. This has come about because shorter needles may not reach the pleural space when inserted under the clavicle in larger patients. The new spot is the typical location for placement of the inevitable chest tube that has to be inserted after needle decompression.

Tension pneumothorax—time for a re-think?

Needle decompression still has a place and is potentially a life saver, but its indiscriminate use should be discouraged. Its potential for failure, the reasons for this, and alternative approaches should be emphasised in teaching. In awake patients it should be performed when there is specific evidence of decompensation although immediate tube thoracostomy is preferred. Otherwise we would encourage that the clinician obtains a chest radiograph to confirm the diagnosis and lateralise the disease while being prepared to perform needle decompression should the patient decompensate.

Resources

EMED

Do NOT x-ray - this is a clinical diagnosis.